American Journal of Epidemiology, Vol 152, Issue 7 658-665, Copyright © 2000 by Oxford University Press
MA Honein, LJ Paulozzi and CA Moore
Although epidemiologic studies of some birth defects have suggested a
gene-smoking interaction, the possibility of this interaction in clubfoot
has not been examined. The authors analyzed risk factors among 346 infants
with isolated clubfoot and 3,029 infants without defects from the Atlanta
Birth Defects Case-Control Study. All infants were born during 1968-1980,
and mothers were interviewed in 1982-1983. The authors examined the family
history-smoking interaction as an indication of a gene-environment
interaction. They defined "smoking" as smoking any time during the first 3
months of pregnancy and "family history" as having a first-degree relative
with clubfoot. Conditional logistic regression (matching variables: race,
birth hospital, and birth period) was used to obtain effect estimates. The
adjusted odds ratios were 1.34 (95% confidence interval (CI): 1.04, 1.72)
for smoking only, 6.52 (95% CI: 2.95, 14.41) for family history only, and
20.30 (95% CI: 7.90, 52.17) for a joint exposure of smoking and family
history. The effect estimate for the joint exposure was higher than would
be expected under either an additive or a multiplicative model of
interaction and showed a statistically significant departure from
additivity. This study confirms the importance of familial factors and
smoking in the etiology of clubfoot and identifies a potentially important
interaction.
ARTICLES
Family history, maternal smoking, and clubfoot: an indication of a gene- environment interaction
Division of Birth Defects, Child Development, and Disability and Health, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA. mrh7@cdc.gov
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